The 2-Day ITB Cure for Endurance Athletes

I got so much feedback from my last article on Perry Nickleston’s RAIL system (which stands for release, activate, integrate, locomote) that I thought it should be explained further.

In particular, with many endurance athletes suffering from ITB issues, I decided to explain exactly how I got rid of my ITB warning in two days. Two days is a far cry from the length of time I usually see athletes suffer with ITB. Most of them deal with it in one for or another for periods of a year or more.

Understand the Root Cause of the Pain

The first step is to understand why the situation happens in the first place. Pain like ITB syndrome or plantar fasciitis often happens with sudden jumps in mileage and training volume. That’s exactly what happened to me.

My bike mileage had been quite low for a few months. That was followed by a three-week trip where I rode only twice, and even then those rides were only on a trainer for an hour or so. But with a half-Ironman race scheduled ten days after I arrived home, I rode five days in a row and put in eleven hours over those five days.

"Is it any wonder my body sent me a warning signal that I was overdoing things? That’s exactly what stage one of pain is – a warning sign."

In other words, I rode more in five days than I had in the two months preceding. Is it any wonder my body sent me a warning signal that I was overdoing things? That’s exactly what stage one of pain is – a warning sign. Failure to address it will often see these minor things become major things that can sideline you for a long period of time.

Tiny Glitches Can Cause Massive Problems

The second reason ITB issues can surface is due to bike setup and pedalling style. Even a tiny glitch can cause massive problems when multiplied out by how many revolutions you are doing sub-optimally over an extended period.

And when you take the damage caused by setup and pedalling style, and then get off the bike and try to run, you’re multiplying your injury risk by even more. This makes triathletes especially susceptible to ITB issues and is why a good bike setup is vital to longevity in the sport. (I’d also suggest videoing yourself pedalling from front and rear so you can see any possible abnormalities in your stroke and correct them.)

Pigeon Stretch

Do Some Release Work

Having been warned by my body that if I kept pushing something truly bad would happen, I immediately dropped the riding out of my training plan for a day. If something hurts you, why on Earth keep doing it? At this point it was Sunday, exactly a week away from my half-Ironman, and in my head I was ready to pull out rather than risk more serious problems.

"If something hurts you, why on Earth keep doing it?"

Following the RAIL system, the first thing I had to do was release work. ITB issues are usually caused by something at the hip not working properly. That means that although I did foam roll my ITB, it had almost no effect. After I performed each movement I would get up and walk around to assess what had the best effect in terms of minimizing the catch at my knee. The thing that made the most difference was a ball in my glute.

The next thing that had the biggest impact was the pigeon stretch. Knowing what muscles do is important if you want to stretch them because the best way to stretch a muscle is to do the exact opposite of its functions. The hip (glute medius) performs hip extension, external rotation, and abduction. Pigeon puts the hip in flexion, a bit of internal rotation, and adduction. So it fits perfectly in this situation.

But that’s not the end of it, as I also wanted some active stretching to bridge the gap between release and activate. The option shown in the video below works well as it is essentially a PNF stretch for the hip. Don’t neglect this step.

Activate the Released Muscles

So, we’ve done release via a combination of changing tissue tone with the ball along with passive and active stretching. Now, we need to activate. That was done, as you can see in the video, by lying face down and going through hip extension, external rotation, and abduction. For many, especially long-term cyclists with tight hips, you may need to also stretch the hip flexors and quads to even allow you to extend the leg off the ground.

Integrate Into a Standing Position

Finally we need to integrate. I chose the single-leg deadlift for this because it hits many things at once and gets us into a standing position to check our function. You must return to standing to see if this whole process has been successful. This is important as quite often I see people run through most of this process in one of the lesser postures (lying, quadruped, or kneeling) and then fail to return to standing for a final assessment.

Test With Locomotion

The next step is to test with locomotion. Walking and running are the two most important primitive patterns we have. There’s so much talk about rolling and crawling, but in both cases those patterns are used developmentally to get us to walking. So when you rehabilitate an injury, make sure you can return to pain-free walking and running - and you’re not just left endlessly crawling around on the ground.

100% Pain Free Running and Riding

I performed this series three times a day for two days and was 100% pain free afterward. In the days since, I have ridden again and been pain free, and my running has been pain free, too.

The key message is to treat ITB issues early before they become full-blown disasters that force you onto the sidelines for an extended period. That will also mean that in the short term you need to lay off the thing that caused the pain in the first place. Pain is a request for change. Ignore it at your own peril.

Finally, make sure to reintegrate yourself with a movement that can be loaded (as load cements movement patterns). The movement should also make the whole body work as a single unit. Isolation work is great in the early stages of rehab, but your healing process must return you to integrated, functional patterns if it to be successful.